title: Clinical prediction of pulmonary embolism in respiratory emergencies.
abstract: BACKGROUND
  The initial management of suspected pulmonary embolism (PE) is commonly done in respiratory departments, but is based on clinical prediction rules developed in other settings.
  
  
  OBJECTIVE
  To determine the accuracy of established prediction rules for PE in patients with respiratory emergencies.
  
  
  METHODS
  A prospective study
  
  
  METHODS
  Patients presenting to respiratory emergency department with acute symptoms and signs suggestive of PE (n=183) and subsequently admitted to hospital were prospectively enrolled. Wells' rule, original and revised Geneva scores, their components separately, and other common clinical parameters were recorded during admission. PE was diagnosed by perfusion lung scanning, computed tomographic pulmonary angiography, lower limb venous ultrasonography, magnetic resonance pulmonary angiography, and/or pulmonary angiography.
  
  
  RESULTS
  PE was confirmed in 52 and ruled out in 131 patients. Tachycardia, atelectasis, elevated hemidiaphragm, clinical signs of deep-venous thrombosis, physician perception that PE is the likeliest diagnosis, previous thromboembolism, chest pain, and absence of chronic obstructive pulmonary disease or cough were associated with the presence of PE. These significant parameters could be combined for accurate pre-test PE prediction, with a newly devised combinatorial tool exhibiting the highest area under curve [0.92 (95% CI: 0.87-0.97)], followed by Wells' rule [0.86 (95% CI 0.79-0.92)], the revised Geneva score [0.83 (95% CI 0.77-0.90)], and the original Geneva score [0.75 (95% CI 0.68-0.83)].
  
  
  CONCLUSIONS
  Wells' rule and the revised Geneva score are more useful in diagnosing PE in respiratory emergencies. A newly devised prediction tool can be of even greater accuracy in this patient population.
authors.affiliation: Department of Critical Care and Pulmonary Services, General Hospital Evangelismos, National and Kapodistrian University of Athens, 3 Ploutarhou Street, 10675 Athens, Greece. atsimog@med.uoa.gr
authors.forename: Angeliki M
authors.initials: AM
authors.lastname: Tsimogianni
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Rovina
authors.forename: Ilias
authors.initials: I
authors.lastname: Porfyridis
authors.forename: Ioanna
authors.initials: I
authors.lastname: Nikoloutsou
authors.forename: Charis
authors.initials: C
authors.lastname: Roussos
authors.forename: Spyros G
authors.initials: SG
authors.lastname: Zakynthinos
authors.forename: Georgios T
authors.initials: GT
authors.lastname: Stathopoulos
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012140:Respiratory Tract Diseases / Q000150:complications*; D018570:Risk Assessment; D012307:Risk Factors